Welcome to my blog. HIV prevalence is not a reliable indicator of sexual behavior because the virus is also transmitted through unsafe healthcare, unsafe cosmetic practices and various traditional practices. This is why many HIV interventions, most of which concentrate entirely on sexual behavior, have been so unsuccessful.

Wednesday, October 16, 2013

[Crossposted from Blogtivist; the link provided to the UN report was to a different report and the correct link has now been provided, apologies for any confusion this may have caused]

Dear High Commissioner Navanethem Pillay

This open letter to you is about one of your recent reports, entitled 'Persons with albinism' (A/HRC/24/57), dated 12 September 2013. Your summary gets to the point: "In some communities, erroneous beliefs and myths influenced by superstition put the security and life of persons with albinism at risk." You also refer to 'ritual' killings and attacks to which many persons with albinism have been subjected over the last six or seven years, particularly in Tanzania. You remark that "[t]he information on the various cases collected by OHCHR came from multiple sources, but the level of verification varies in each case.

It is this level of verification that especially interests me. Earlier in the report you stated that "[t]he collection and verification of cases of ritual attacks is a challenge due to the secret nature of witchcraft rituals, the inability and/or fear of victims’ relatives to report such incidents...[etc]." I would suggest that, from the earliest killing reported in the international media, widely believed to emanate from the BBC, all witchdoctors and other people reputed to be engaged in witchcraft, or related activities (very different sorts of activity among which the BBC makes no useful distinction), have been thus implicated in the attacks.

I hardly need to remind you what that means. Many people, in Tanzania and other countries, have been persecuted by mobs, even lynched, because of the belief that they were engaged in witchcraft or something similar. Indeed, what may have been the first 'ritual' killing of a person with albinism, reported in the Legal and Human Rights Center in their 2006 report, is a brief mention of two men who were lynched by a mob; the brief mention is, essentially, about the killers themselves, not their victim. Your report does not mention the Tanzanian Witchcraft Ordinance of 1928, which proscribes public accusations of witchcraft without providing evidence that the accused actually practiced witchcraft or claimed to possess witchcraft powers, etc, but I’m sure you are acutely aware of the risks that those merely suspected of witchcraft, and even those investigating attacks on persons with albinism, face.

I needn't labor the point; witchdoctors have very good reason to be secretive, especially when everyone points the finger at them following the (rether frequent) occasions on which the media sees fit to implicate them. I'm sure you haven't forgotten earlier stories about the 'skin trade' in Tanzania, 'devil worship' in Kenya and various other phenomena more notable for the vast number of column inches dedicated to them that to the substantive content of the various reports that came to be written about them.

Your report notes that victims, their relatives and fellow community members are afraid to report killings. But it's only natural to fear those who are thought to have magical powers, and worse, to be so ruthless that they would attack people with machetes to maim and/or kill them, or even to instigate such a killing. However, could people actually be more afraid of the absolute demons they read about in the press than anything they have ever experienced? Could they be afraid of something they have never seen, but which they are assured by everyone who has read these reports, exists among them and wields a terrible power over them?

As you say, levels of verification are important. The vast quantity of media coverage may one day yield up something that constitutes evidence of such devotion to superstitions that it leads to maimings and killings; the small handful of sources of information on which the media depends, and on which your preliminary report now depends, may have some checkable, some verifiable source of information that lies, however hidden, behind it. Perhaps this could be used to carry out an investigation into some of the killings, at least the ones for which there is even a minimum level of documentation.

But I would suggest that the media itself has often been secretive, a bit ritualistic, even a bit fetishistic, at times. They constantly refer to things as if they have evidence, words like 'official' are used (although few journalists, if any, seem to view the police, or any other commonly used informants in such cases, as a possible source of anything except further unsubstantiated information, ridicule, stories about corruption, predictable stuff), they write as if the very dogs on the streets know that all these attacks were carried out by witchdoctors who paid 'middlemen' to 'obtain' body parts of people with albinism, for which 'rich and powerful' people pay large amounts of money to ensure that they become more rich and powerful.

It's a very credible story, in a sense, given the many other incredible stories we are told about Africans or, in this case, Tanzanians; a story of superstition, poverty, bullying by rich people, incompetence by 'officials'. But it's a story for which the media provide little or no evidence. Tanzanian people may well have been convinced that witchdoctors are rich and powerful, and that they themselves could become rich and powerful by working for them, or for their rich and powerful clients. But, aside from the plentiful supply of gossip, where is the evidence? Or should I ask what constitutes evidence in these cases? If the sheer number of media reports constituted evidence, all Tanzanian witchdoctors (and those thought to be witchdoctors) would be locked up, perhaps even condemned to death. But none, as far as I know, have been executed (unless some have been killed by mobs). Few have even been through the courts.

I truly hope any evidence that exists that sheds light on these attacks on people with albinism is going to be handed over to you by those who have generated so many media reports based on what seems to them to be so certain. Your preliminary report suggests that little new evidence, with a reasonable level of verification, has yet been made available to you. It is to be hoped that all will be revealed in the final report, after a thorough investigation, one that looks critically at the assumptions we have been making for around seven years without putting a stop to the attacks, apprehending the attackers, or protecting the victims and those around them.

As things stand right now, perhaps there is something wrong with our assumptions? The practice of 'witchcraft' was banned without that preventing further attacks. Over 170 people were allegedly arrested, and let go (at least, I hope they were let go). Apparently over 70 of them said they had been told by witchdoctors to bring them albino body parts. Could this be an important lead? Or could it suggest that everyone reads what has been written in all the papers for months, or talks to someone who does? None of these people were convicted. That could be because there was no evidence, aside from the fact that they were witchdoctors, suspected of being witchdoctors, associated with witchdoctors, etc.

Or maybe they were not involved, or not even completely aware of what was going on, aside from what they read in newspapers or heard from people who read them, or claimed to? The media calculated and recalculated the figures for victims and deaths: there were 4 in December 2007 but 20 by January 2008, without any media report that I could find accounting for any of these new attacks by providing basic details; who were all these victims? Generally we don’t even know their names, sometimes not even their gender. Was their body discovered somewhere, or was there even a body? You may think these are silly questions, because the media eventually agreed by some time around 2012 that there were over 70 deaths. But how starkly all this contrasts with reporting on murders in Western countries, where some of them become household names; at least we get the basic details.

According to the media accounts that I have looked at there were well over 30 deaths that attracted enough media interest for something about the incident to be recorded, the age, location or some circumstance, such as 'skinning' of the victim. There were well over 70 documented attacks. Not over 70 killings, as the media eventually agreed, but as I said, they could be keeping their cards close to their chest. But attacks continue. Media coverage has waned considerably since 2008 and 2009, but I have tried to account for documented victims in the linked table and I would welcome additions to it.

You will, no doubt, have read a lot already, possibly coming across odd recurrences and even more odd contradictions, even convenient, but unsubstantiated juxtapositions. You will probably even notice that predictions, such as the fear that lots of persons with albinism would be maimed and killed before the 2010 Tanzanian elections turned out to be unfounded? It doesn't say that in the mainstream media, as far as I know, but nor could I find any articles about a noticeable uptick in attacks. Documented victims peaked in 2008, but again in 2011. There was a big dip in 2009 (without a corresponding dip in media coverage), with a further dip in 2010, by which time media coverage began an exponential decline that has continued for several years. I quite accept, of course, that my data is limited to what is available, free of charge, online; the media may have access to other information to which I am not privy, but to which, I hope, you are privy.

To conclude: you mention 'erroneous beliefs and myths, heavily influenced by superstition' in your analysis of attacks on persons with albinism. I would add to that a set of erroneous beliefs and myths that are heavily influenced, even promoted, by the media. If people believe in the great power of witchdoctors, and believe that they can get paid a lot of money to carry out a maiming or a murder, they are quite wrong, and it behooves the media to make that completely clear, now. But why would ordinary Tanzanians even believe such a thing? Perhaps they deserve to be condemned for being stupid enough to commit a terrible crime on the stuff of rumor and gossip. But ordinary Tanzanians themselves are not the source of all rumor and gossip, nor are they the sole spreaders of rumor and gossip.

If it is the case that not all witchdoctors are so powerful and so ruthless, that not all 'middlemen' (and what ordinary Tanzanian could not, going by media descriptions, fill that role?) are so greedy or so gullible, even that most ordinary Tanzanians living in rural communities (and we are frequently told about levels of superstition in rural areas) are not so cowardly or so despicable as to turn a blind eye, or to conspire with other parties, as to maim and kill members of their own community or their own family 'because of their superstition', or worse, because of lust for money, then the entire investigation of the attacks needs to begin again.

Why? Because the received view of these attacks needs to be called into question. We simply don’t know much for sure about witchcraft, a ‘trade’ in body parts, or a ‘rich elite’ that is willing to pay large sums of money for goods and services provided by witchdoctors; we don't know who we are looking for, what they are like, how many they are, aside from the suggestions provided by the media.

I believe it is vital for us to understand the root causes of attacks and discrimination, and your report refers to these among your recommendations. However, the distinction between the causes of the attacks and the causes of the discrimination is just as vital. The attacks are a relatively new phenomenon, even various media cited sources agree on that. But the discrimination goes back decades, perhaps centuries, and affects the millions of disabled people living just in Tanzania alone (an estimated 2% of the population), to this day, not just the tens of thousands of persons with albinism (or hundreds of thousands, depending on which article you read).

Media reports, and other reports depending on media reports, do not constitute a solid foundation on which to base further investigations. I am sure you are aware of that, but what I have read so far, in the media and in other reports, is highly questionable. Yet I see virtually the same material in your preliminary report. It is not my intention to advise you, only to urge you that the current body of data on attacks on people with albinism may not yet be very reliable.

I look forward to a report that results in the protection of persons with albinism, brings perpetrators of violence to justice and ensures that these attacks never happen again. Following the publication of the report, persons with albinism, those associated with them, those associated with attacks on them, and all other innocent people, will enjoy those human rights that have, up to now, been denied them.

In addition to compiling a web page of documented attacks, to which I have provided a link, I have various other data that I have collected. If I can be of any assistance to you or your officers, please do not hesitate to get in touch with me.

Saturday, October 12, 2013

Following a facile article in favor of mass male circumcision on the Poz.com site (which I discuss on another blog), where the author went to some lengths to pretend he was not in favor of it, there is an article defending circumcision as a religious rite for Jewish people, with even a single mention of Muslims (at a time when even vaguely pro-Muslim, or non-anti-Muslim, sentiment in the media is particularly unfashionable) in the English Guardian. The title of the Guardian article reads: "A ban on male circumcision would be antisemitic. How could it not be?" The article purports to be a response to the Council of Europe's 'comparisons' of male genital mutilation with female genital mutilation, with the author claiming there is no acronym for the former, suggesting that she has familiarized herself with neither the literature nor the operation.

But enthusiasm for circumcision is not confined to the operation as a religious rite. The big money is behind it as a 'preventive' against HIV and several sexually transmitted infections. Starting with adults and teenagers as targets for mass male circumcision campaigns, proponents have long been setting their sights on infants. Never mind the fact that most infants don't engage in any kind of sexual behavior, least of all a kind that would be claimed to increase the risk of HIV transmission in those who have not been circumcised, not even by the most rabid proponent of the operation. Proponents of circumcision *want* to circumcise everyone, at all costs. What could be easier than starting with Africans, about whom few in the media care very much.

What has the Poz.com argument got to do with the Guardian article? After all, Poz.com is promoting circumcision for its claimed protection against HIV and the Guardian is promoting it as a religious rite. Well, both articles argue for the mainstream, financially sound view, the view that doesn't fly in the face of current political sentiment and, more importantly, doesn't fly in the face of important funders and supporters. Poz.com depends on big pharma for its funding, along with some other wealthy institutions. The Guardian does not (entirely), but the Guardian's Development section is funded by the Gates Foundation. That is higly significant when it comes to circumcision: the Gates Foundation is not just pro-circumcision, it funds one of the three main websites that promote circumcision, the Clearinghouse on Male Circumcision for HIV Prevention (the other two are the WHO and USAID).

In fact, the Foundation has also funded research carried out on African participants, research that is highly questionable, ethically as well as empirically. The Guardian's article doesn't appear on their Development section, but the connection with as huge a figure in the realm of circumcision promotion as Bill Gates is of a significance that should not be dismissed lightly. In addition, the Guardian article defends circumcision as a religious rite, but the Poz.com article, by implication, opposes non-circumcision as a cultural right. Ethically and empirically dubious arguments are being shoved down the throats of Africans who do not currently circumcise, by people who do not consider for one moment that others have the right to choose not to circumcise, for cultural reasons. In Kenya, for example, it is for cultural reasons that members of the Luo tribe do not circumcise, and the same goes for many other Africans. It is not because they, like the Europeans, do not believe that the reasons given for mass male circumcision are completely unconvincing (arguments that have changed many times over the decades, except in the fervor with which they are expressed).

Back to Tanya Gold's arguments in the Guardian. The Council of Europe, astutely enough, used the phrase violation of the physical integrity of the body' to describe male circumcision. Even defenders of the operation could hardly deny that it violates the physical integrity of the body, could they? After all, that's the point of it, as a rite and as a putative protection against HIV. Gold doesn't tell us if she would object if the Council had attempted to suggest that parents be allowed to wait until their boys were old enough to decide whether to be circumcised or not. After all, compromises have been made before. Religious and cultural rites have been modified, even abandoned altogether. Tattooing and body piercing are not banned, but people are not permitted to tattoo and pierce parts of their babies, or even their children. These also violate the physical integrity of the body, although many people believe that they are worth having, for cosmetic or other reasons.

Even Gold is 'repulsed' by certain conditions that may surround circumcision, as if these conditions are not common. But most circumcisions are carried out in non-sterile, non-clinical conditions. In fact, like the violation of the physical integrity of the body, this is what makes them a matter of religious or cultural rite, rather than an operation that people can have carried out in a hospital, preferably when they are old enough to decide if they want to have their foreskin removed. Gold is not arguing for these conditions, but she is arguing for the religious right to perform circumcisions, and (perhaps) for the cultural right (or maybe she only considers Jewish circumcision to be worth defending? She is not clear on this.) Would Gold consider allowing parents to wait until their son could decide for himself? We expect those who perform rites and rituals we (in the West) consider repulsive, harmful, etc, to compromise or even abandon those rites and rituals. Why not discuss such a compromise with those who practice circumcision?

Gold objects to calling ritual circumcision a 'violation of children's rights'. But if there are exceptions to a law against violation of children's rights, and violation of the physical integrity of the body in particular, how does this affect other children's rights, even human rights in general? Can you argue that certain rights should be denied to those infants where parents believe that that would constitute a denial of their own religious rights to circumcise their child? Are human rights not interrelated, interdependent and indivisible: Gold seems to believe that circumcision does not involve violation of the physical integrity of the body, which is ridiculous, though she may prefer a different way of expressing the same thing. But she also seems to believe that circumcising infants is not a violation of their rights, and that banning infant circumcision denies parents their rights. She doesn't make the distinction between infant circumcision and adult circumcision, but she seems to believe that the Jewish rite necessarily requires that it be carried out on infants.

Sadly, Gold has confined her arguments to the rights of Jewish people and chosen to write about antisemitism, rather than dealing with the broader issues of circumcision, human rights, the right to choose (particularly the right to choose not to circumcise), children's rights and the like. True, she stuck her neck out by using the word 'Muslim' once and had the temerity not to include any other words beloved by journalists and home office officials as an accompaniment to the word 'Muslim', but she is clearly not in the business of standing up for what she believes in. It's almost as if it's not her job to believe in things. She invokes the typical 'slippery slope' argument: if circumcision is a "human rights violation against children... This is a trend – and so of course the next stage is prohibition." We wouldn't want to use emotive arguments, would we? There is a "dark marriage between human-rights agitators and racists", according to Gold.

Which means that in objecting to infant circumcision, either as a religious rite or as a means of 'preventing' HIV, I am not just an antisemite, but I am also in bed with racists. I am supporting the "removal of Jews from Europe". There was me thinking that I was arguing for human rights and against abuses of human rights, especially ones that journalists typically ignore, such as the rights of people who are not wealthy, or powerful, or perhaps people who are not even Guardian readers (who?), although I read the Guardian myself. Gold ends her piece with a sentiment that I would agree with if it were about journalists: "some Jews are always packed in their minds". But I can't reassert my credentials as a defender of human rights by accusing a journalist of having views that are formed independently of thought, evidence, logic or humanity; that's shooting fish in a barrel.

Wednesday, October 2, 2013

The website 'poz.com', which is about HIV, but from a US point of view, has a recent article on circumcision by Ben Ryan, who is apparently a journalist. The strapline reads "Major studies support circumcision as prevention in Africa but a small yet vocal group argues the science is flawed. Can circumcision lower U.S. HIV rates?" The question is odd, because the article is not primarily about whether the operation can or can not lower transmission in the US (Ryan seems to suggest the answer is 'yes', but in a country where HIV transmission is predominantly among men who have sex with men and intravenous drug users, 'no' seems much more likely to be correct). The article is not really about the science either, but rather how that 'science' is used. (Even the title, 'Cut to Fit', sounds like an ironic reference to the author's journalistic style.)

Ryan gives a selective review of the 'science' as he sees it, listing the major players in circumcision promotion, major in terms of the funding they receive, anyway. But all this is contrasted to an 'ideological war', by what Ryan brands as a small group of 'dissidents'. The fact that many of those who oppose the imposition of mass male circumcision on tens of millions of African men who are not already circumcised, and male infants born to people who would not normally choose circumcision in infancy, are also scientists doesn't seem relevant. The facts that skepticism is not inherently unscientific and that not all those who oppose mass male circumcision can correctly be referred to as 'dissidents' also seem unimportant to Ryan.

Although Ryan enjoys the term 'intactivist' to refer to people who oppose mass male circumcision on the grounds that the 'science' is highly flawed, this is not a widely used term by opponents. Some, like myself, oppose mass male circumcision on human rights grounds, and on the grounds that insisting on every man conforming to what is an American preference is an outrageous instance of cultural imperialism; but I certainly wouldn't call myself an intactivist. According to Ryan, those who oppose mass male circumcision are mainly Americans and Europeans, without pointing out that those who promote it are almost all American, and all their funding is from America.

Part of the pretence of 'giving both sides of the story' involves interviews with people whom Ryan subtly belittles. One of those interviewed is John Potterat, who has carefully outlined the reasons for skepticism about the 'scientific' literature, which is freely available on the Social Science Research Network. According to Ryan and his favored informants, 'dissidents' are 'hampering progress', 'spreading misinformation' and 'creating skeptics among those who stand to benefit', the last referring to African people, whose future is being put in jeopardy because of a handful of unscientific people who are not epidemiologists or health scientists, and therefore should not hold an opinion on human rights or cultural imperialism, or so Ryan wants us to believe.

Ryan also interviews Rachel Baggaley, who has an MD, who reassures us that the three million figure the WHO claims have been circumcised under the program sounds very low beside the 20 million originally hoped to 'benefit' from the operation because 20 million was 'aspirational'; that the WHO had "underestimated the complexities and social sensitivities required to successfully promote the program in certain populations". Could some of these 'social sensitivities' be similar to the views of the people Ryan considers to be a mere fringe of 'dissent? What Baggaley is delicately referring to is a dearth of safe health facilities, experienced health personnel and supplies needed to provide mass male circumcision that doesn't result in a lot of botched operations and a huge increase in hospital transmitted HIV; also, that infuriating barrier to US cultural imperialism: foreigners, non-Americans.

While presenting arguments against mass male circumcision in a context that makes them futile, Ryan lists the arguments for the program as if they were some kind of holy grail of truth, true for all time, in all places, as true for non-Americans as for Americans. Those pushing for the program keep going on about how similar the results of all the randomized controlled trials were, without this being held up to any kind of questioning; were these crusaders really so lucky, that all three trials came up with almost the same results? Why were the trials carried out in those areas, among those people, with those specific (poorly described) methodologies? Were any other trials carried out that may show the opposite effect? And why are the mass male circumcision programs going ahead in areas where HIV prevalence is already higher among circumcised men than uncircumcised men? What about current programs that are currently suggesting that mass male circumcision programs seem to be increasing HIV transmission, in Botswana and Kenya?

Oddly enough, Ryan gives the last word to Baggaley, who now refers to those who oppose the US funded mass circumcision of African men as 'denialists'. She says they are generally not from high HIV prevalence countries, as if those promoting the program are. Seeing herself as having the perspective of a 'young man in South Africa', she finds objections to the operation to be 'paternalistic'. Evidently she doesn't see the paternalism in spending billions of US dollars on persuading people to be circumcised by telling them that there are numerous advantages to be enjoyed. How is that different from the various (also US funded) efforts to persuade poor people to be sterilized? How is that different from various syphilis 'experiments' carried out on African Americans, or similar ones carried out in Guatemala?

In stark contrast to Ryan's stance of appearing to be 'giving both sides of the argument' while achieving no such thing, Brian D Earp has written a very cogent rebuttal of all the bits and bobs that Ryan thinks of as science. Earp does put his cards on the table: he is not undecided about whether mass male circumcision is a good or bad thing. But neither is Ryan, he just pretends to be. If you are interested in reading solid rebuttals of the arguments of those claiming to be 'scientists', and others, it's worth reading Earp's article in full. I can not do it any justice by paraphrasing it.

To conclude, branding people as 'denialists' or as being 'unscientific', even when the point is not a scientific one, or not entirely a matter of science, has a long history. Journalists pretending to be (or thinking that they are?) even handed is also an old trick. So people have to think for themselves: would you do it to someone you love, or would you wait till they were old enough to decide for themselves? And even if your answer is 'yes', and you would circumcise your son when he's still an infant, does that mean tens of millions of African men should be persuaded by the US (and by US funded 'Kofi Annan' type figures) to do the same, using a hotch-potch of scare stories, half baked theories and outright lies, all dressed up as some kind of scientific canon, and that tens of millions of African infants should also be circumcised, their parents having been primed using the same body of 'evidence'?